COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

Article by Kenneth Minkoff, MD and Christie A. Cline, MD
http://www.kenminkoff.com/article2.html
Page 3 of 23
4/26/2006
the needs of individuals with cod, and plans to create funding mechanisms to support state level or regional
initiatives to build better service capacity for cod within the entire service system. The Report to Congress
provides anecdotal information on a number of state projects already in progress, specifically referencing a
Technical Assistance document commissioned by SAMHSA describing one such project (the New Mexico Cooccurring
Disorders Service Enhancement Initiative (NM-CDSEI) [7], which utilized the CCISC model to
organize a system wide implementation of integrated services. The Report to Congress also references the
Comprehensive Continuous Integrated System of Care (CCISC) model utilized in the NM-CDSEI as a best
practice model for system design for co-occurring disorders.
The purpose of this paper is to describe the CCISC model, to outline a strategic implementation process
termed the “12 Step Program of CCISC Implementation, and then to describe examples of current CCISC
implementation projects in the United States and Canada, along with information on project evaluation and
outcomes.
CCISC
The CCISC was first outlined by Minkoff [8], organized and elaborated as part of a national consensus
best practice development project [9] and first utilized in a formal consensus process in Massachusetts in 1998-
1999. [10] The CCISC model is built on 8 evidence based principles of service delivery for co-occurring
disorders that provide a framework for developing clinical practice guidelines for treatment matching [11] and
can also be utilized to design a welcoming, accessible, integrated, continuous, and comprehensive system of
care, initially within the context of existing resources. The rationale for system design is that dual diagnosis is
an expectation in all settings, associated with poor outcomes and high costs in multiple domains, so that
attention to cod must be a priority in all system activities and in the utilization of all system resources.
Consequently, the system must require all programs to be designed as “dual diagnosis programs” by meeting
minimal standards of “dual diagnosis capability” (DDC) [12], initially within existing program resources, (The
system may also plan for some program components to be specifically designed as Dual Diagnosis Enhanced
(DDE), but with the understanding that each program has a different “job”, providing organized matched
services to its existing cohort of dually diagnosed clients, utilizing the treatment matching principles to